Do you know what my three favorite diagnoses are?
I'll give you a hint: they all only occur in first-world countries. They are strongly linked to obesity, depression and anxiety. And there are no laboratory tests, scans or xrays that can reveal them.
They are only diagnosed by ruling out other possible causes. They are then, "default" diagnoses.
Nurse's Note: "Default diagnoses" come and go fashionably. What ever happened to Chronic Fatigue Syndrome?
Okay, here they are, my top three:
1. Cyclic Vomiting
Do you know what will stop cyclic vomiting? Four milligrams of hydromorphone pushed intravenously. Hydromorphone is an powerful narcotic given to people dying of pancreatic cancer or who have had their leg chopped off by a chainsaw.
And, for cyclic vomiting.
Note: you will never actually SEE these patients vomit, though they complain of constant nausea. And there is always, ALWAYS a hovering enabler with them, usually a woman.
Do you know how to spell, "cyclic vomiting"?
"F-A-K-I-N-G-I-T"
Do you know what will stop cyclic vomiting? Four milligrams of hydromorphone pushed intravenously. Hydromorphone is an powerful narcotic given to people dying of pancreatic cancer or who have had their leg chopped off by a chainsaw.
And, for cyclic vomiting.
Note: you will never actually SEE these patients vomit, though they complain of constant nausea. And there is always, ALWAYS a hovering enabler with them, usually a woman.
Do you know how to spell, "cyclic vomiting"?
"F-A-K-I-N-G-I-T"
2. Pseudo-Seizures
A patient with a real seizure disorder has a big problem. Since they may seize at any time, their lives are extremely restricted. They can't drive; often they can't work. If we can discover EXACTLY where in their brains the seizures are coming from, neurosurgeons can resect that area and the patients can stop their anti-seizure medications and live normal lives.
To find out where these seizure "storms" are coming from, we bring the patients into the hospital and stop all their seizure medications. We hook them up to a continuous EEG monitor and wait.
And wait.
And wait.
It’s the, "watched pot never boils" syndrome. It can take weeks, but we have to get three seizures on the EEG strip. We keep the patient up all night, stimulate them with flashing lights, noise, television, anything, trying to get them to seize. It’s frustrating for everyone.
A patient with pseudo-seizures is different.
Nurses can always tell within 7.1 seconds if the patient has pseudo-seizures. You walk into the room and before you can say, "Hi, I’m your nurse--" they will have a "seizure". They will prove it to you!
Questions asked during this "seizure" often get answers. If you lift up their arm, hold it over their face then drop it, the arm won’t hit their face. It will fall beside it.
What will cure pseudo-seizures is pushing two milliliters of normal saline IV while loudly announcing, “This will stop it if it is a real seizure”.
The seizure will always stop.
Do you know how to spell, "pseudo-seizures"?
"A-T-T-E-N-T-I-O-N-S-E-E-K-I-N-G".
A patient with a real seizure disorder has a big problem. Since they may seize at any time, their lives are extremely restricted. They can't drive; often they can't work. If we can discover EXACTLY where in their brains the seizures are coming from, neurosurgeons can resect that area and the patients can stop their anti-seizure medications and live normal lives.
To find out where these seizure "storms" are coming from, we bring the patients into the hospital and stop all their seizure medications. We hook them up to a continuous EEG monitor and wait.
And wait.
And wait.
It’s the, "watched pot never boils" syndrome. It can take weeks, but we have to get three seizures on the EEG strip. We keep the patient up all night, stimulate them with flashing lights, noise, television, anything, trying to get them to seize. It’s frustrating for everyone.
A patient with pseudo-seizures is different.
Nurses can always tell within 7.1 seconds if the patient has pseudo-seizures. You walk into the room and before you can say, "Hi, I’m your nurse--" they will have a "seizure". They will prove it to you!
Questions asked during this "seizure" often get answers. If you lift up their arm, hold it over their face then drop it, the arm won’t hit their face. It will fall beside it.
What will cure pseudo-seizures is pushing two milliliters of normal saline IV while loudly announcing, “This will stop it if it is a real seizure”.
The seizure will always stop.
Do you know how to spell, "pseudo-seizures"?
"A-T-T-E-N-T-I-O-N-S-E-E-K-I-N-G".
3. Fibromyalgia
My third, most very favoritist diagnosis in the WHOLE WORLD is fibromyalgia!! These patients have chronic pain. They just hurt everywhere! They can’t have a job because of their "illness". Nothing can ever be expected or demanded of them. Their list of pain medications and anti-anxiety medications and anti-depressant medications is as long as the Trans-Siberian Railroad. And they are just nearly always single, obese white women who watch a lot of daytime television.
They will ask you point-blank to push their drugs fast into the closest IV port for the rush. If they are conscious, they are miserable. Do you know how to spell, "fibromyalgia"?
"D-R-U-G A-D-D-I-C-T”
My third, most very favoritist diagnosis in the WHOLE WORLD is fibromyalgia!! These patients have chronic pain. They just hurt everywhere! They can’t have a job because of their "illness". Nothing can ever be expected or demanded of them. Their list of pain medications and anti-anxiety medications and anti-depressant medications is as long as the Trans-Siberian Railroad. And they are just nearly always single, obese white women who watch a lot of daytime television.
They will ask you point-blank to push their drugs fast into the closest IV port for the rush. If they are conscious, they are miserable. Do you know how to spell, "fibromyalgia"?
"D-R-U-G A-D-D-I-C-T”
Not one person living in Leningrad in 1942 had cyclic vomiting. No one in Andersonville prison during the Civil War had pseudo-seizures. And no Libyan woman trying to escape a terror regime with her children had fibromyalgia.
Maybe it’s our latitude?
The Fibromyalgia Fairy
(c) copyright 2012 by the author of this blog. All rights reserved.
And although a patient with pancreatic cancer, writhing in pain, and dying within the next 3 days, will always appreciate your kindness, patients with any (or all, as studies show that these conditions share the same self- centerdness genetic link), of these conditions, thrive in being assholes to medical, nursing, and janitorial personel!
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